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Based on staff interviews, clinical record review, and Emergency Department's (ED) policy and procedures review, the hospital failed to comply with 42 CFR § 489.24 - Special Responsibilities of Medicare Hospitals in Emergency Medical Treatment and Active Labor Act (EMTALA).

Findings:

The facility failed to follow its policy and procedure for transferring patients to a higher level of care (a hospital capable of providing diagnostic, intervention or care beyond the capacity of the hospital from which a patient originates) and did not have a current contract for emergent air transfer (air ambulance) of patients with the air ambulance company (AA 6). In practice, AA 6 assumed responsibility (including medical management and Physician Orders) of Hospital 2's patients during transportation to a higher level of care, but facility policy indicated Hospital 2 was responsible for its patients during transport until arrival at the receiving facility.

This failure could potentially contribute to unsafe patient transfers when medical responsibility for a patient's care during transport was not clearly identified between Hospital 2 and the transportation company.

Based on staff interviews, clinical record review, and policy and procedure review, Hospital 2 did not follow its policy and procedure for transferring patients to a higher level of care (a hospital capable of providing diagnostic, intervention or care beyond the capacity of the hospital from which a patient originates) and did not have a current contract for emergent air transfer (air ambulance) of patients with the air ambulance company (AA 6). In practice, AA 6 assumed responsibility (including medical management and Physician Orders) of Hospital 2's patients during transportation to a higher level of care, but facility policy indicated Hospital 2 was responsible for its patients during transport until arrival at the receiving facility.

This deficiency could potentially contribute to unsafe patient transfers when medical responsibility for a patient's care during transport was not clearly identified between Hospital 2 and the transportation company.


Findings:

During a concurrent interview and emergency medical record review on 9/19/24 at 3:50 p.m.., the Emergency Department (ED) Director stated P9 arrived in the ED on 4/2/24 at 3:01 a.m., with complaints of shortness of breath. A review of P9's Provider Notes, dated, "4/2/24," indicated (P9) was a 3 year-old male with a history of trisomy 21 (a genetic disorder that occurs when a person has a extra copy of chromosome 21) and atrioventricular canal defect (occurs when there are holes between the chambers of the right and left side of the heart) which had been repaired. Despite maximal medication therapy, P9 continued to decline and was intubated (a medical procedure that involves inserting a tube into the wind pipe to keep the airway open) at 5:01 a.m. on 4/2/24. Hospital 4 accepted transfer of P9 at 7:02 a.m., was transferred to Hospital 4 by airplane (air ambulance; AA 6) out of Hospital 2 at 7:37 a.m. on 4/2/24. The ED Director was asked about Hospital 2's Physician Orders to manage P9 safely during the transport to the accepting facility and stated Hospital 2 did not manage the patients while they are being transported with AA 6, since the company had a medical provider who managed the patients during transport and coordinated with the receiving facility. The ED Director stated the Physicians at Hospital 2 coordinated with the receiving facility but when AA 6 transported the patient, the company assumed care of the patient because of a contract between AA 6 and Hospital 2 so Hospital 2 would not write orders or further care management of the patients during transport. The ED Director stated the contract between AA 6 and Hospital 2 had actually expired but there was a meeting scheduled for some time soon (date unknown) to work on the contract.

During a concurrent interview and emergency medical record review on 9/19/24 at 4 p.m., the ED Director stated Patient 10 arrived in the ED on 4/25/24 at 12:07 a.m., with complaints of right ear pain. A review of P10's Provider Notes, dated, "4/25/24," indicated (P10) was a 6 year-old female with complaints of right ear pain. P10 was diagnosed with external otitis (an inflammation of the ear canal that can be caused by infection) and Otomastoiditis (inflammation of the mastoid and middle ear) and accepted at Hospital 4 at 8:40 p.m. on 4/25/24. AA 6 transported P10 on 4/25/24 at 6:50 a.m. due to weather, it was not safe to fly or or transport P10 until that timeframe.

During a review of the emergency record, P23 arrived in the ED on 8/3/24 at 10:43 a.m., with complaints of burns on her face. P23 was accepted to Hospital 5 (burn unit) and transported on 8/3/24 at 1:45 p.m., by AA 6.

During an interview on 9/19/24 at 4 p.m., the Area Manager of Accreditation Regulatory and Licensing (AR&L) stated there was no contract with AA 6 since it had expired about two years ago and could not explain why there was not a new contract in place.

During a concurrent interview on 9/19/24 at 4:42 p.m., the Chief Nursing Officer (CNO) stated it was not the policy for Hospital 2 to manage the care of patients being transported by AA 6; the company had a medical provider who managed the patients and coordinated with the receiving facility regarding the care of the patients. The CNO stated she was unaware of the policy, and stated AA 6 managed the patients, they had a medical director who took over the care, and there were protocols their staff would follow and there were transfer agreements between Hospital 2 and AA 6.

A review of facility policy titled, "RECIPROCAL TRANSFER AGREEMENT," dated 8/31/21, indicated, "2.3 The Transferring Facility ... *** shall assume responsibility for the patient's care and safety during transport ....Receiving Facility shall not be responsible for the patient until arrival at Receiving Facility." The policy further indicated......"The Transferring Facility shall arrange and coordinate the method of the transportation of the patient to the Receiving Facility and shall assume responsibility for the patient's care and safety during transport ..."